Evaluation of navigation and robotic systems for percutaneous image-guided interventions: A novel metric for advanced imaging and artificial intelligence integration.

Purpose: Navigation and robotic systems aim to improve the accuracy and efficiency of percutaneous image-guided interventions, but the evaluation of their autonomy and integration of advanced imaging and artificial intelligence (AI) is lacking. The purpose of this study was to evaluate the level of automation and integration of advanced imaging and artificial intelligence in navigation and robotic systems for percutaneous image-guided interventions, using established and novel metrics to categorize and compare their capabilities.

Materials And Methods: Following PRISMA guidelines, a systematic review was conducted to identify studies on clinically validated navigation and robotic systems published between 2000 and May 2024. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data on navigation devices were extracted and analyzed. The levels of autonomy in surgical robotics (LASR) classification system (from 1 to 5) was used to analyze automation. A novel taxonomy, the Levels of Integration of Advanced Imaging and AI (LIAI2) classification system, was created to categorize the integration of imaging technologies and AI (from 1 to 5). These two scores were combined into an aggregate score (from 1 to 10) to reflect the autonomy in percutaneous image-guided intervention.

Results: The review included 20 studies assessing two navigation systems and eight robotic devices. The median LASR score was 1 (Q1, Q3: 1, 1), the median LIAI2 score was 2 (Q1, Q3: 2, 3), and the median aggregate score was 3 (Q1, Q3: 3, 4). Only one robotic system (10 % of those reviewed) achieved the highest LASR qualification in the literature, a level 2/5. Four systems (40 %) shared the highest rating for LIAI2, which was a score of 3/5. Four systems (40 %) achieved the highest aggregate scores of 4/10.

Conclusion: None of the navigation and robotic systems achieved full autonomy for percutaneous image-guided intervention. The LASR and LIAI2 scales can guide innovation by identifying areas for further development and integration.